Predictive value of positional change in vital capacity to identify diaphragm dysfunction

Brault, Marilyne; Gabrysz-Forget, Fanny; Dubé, Bruno-Pierre

doi:10.1016/j.resp.2021.103668

Cited by 13 publications

(9 citation statements)

References 42 publications

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“…Moreover, we demonstrate a clear association of PN caliber and spirometric measures of respiratory function, especially ΔFVC. Sitting-to-supine fall in vital capacity is a well-established indicator of bilateral diaphragm dysfunction [29]. Our finding that PN, rather than AN, atrophy predicts lowered FVC (especially supine FVC) is in agreement with the well-documented dominant contribution of diaphragm over other respiratory muscles to the inspiratory volume, which largely determines vital capacity [30].…”

Section: Discussionsupporting

confidence: 87%

Ultrasonic detection of vagus, accessory, and phrenic nerve atrophy in amyotrophic lateral sclerosis: Relation to impairment and mortality

Walter,

Sobiella,

Prudlo

et al. 2023

Euro J of Neurology

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Background and purposeIn amyotrophic lateral sclerosis (ALS), phrenic nerve (PN) atrophy has been found, whereas there is controversy regarding vagus nerve (VN) atrophy. Here, we aimed to find out whether PN atrophy is related to respiratory function and 12‐month survival. Moreover, we investigated the relevance of VN and spinal accessory nerve (AN) atrophy in ALS.MethodsThis prospective observational monocentric study included 80 adult participants (40 ALS patients, 40 age‐ and sex‐matched controls). The cross‐sectional area (CSA) of bilateral cervical VN, AN, and PN was measured on high‐resolution ultrasonography. Clinical assessments included the Amyotrophic Lateral Sclerosis Functional Rating Scale–Revised (ALSFRS‐R), the Non‐Motor Symptoms Questionnaire, and handheld spirometry of forced vital capacity (FVC). One‐year survival was documented.ResultsThe CSA of each nerve, VN, AN, and PN, was smaller in ALS patients compared to controls. VN atrophy was unrelated to nonmotor symptom scores. PN CSA correlated with the respiratory subscore of the ALSFRS‐R (Spearman test, r = 0.59, p < 0.001), the supine FVC (r = 0.71, p < 0.001), and the relative change of sitting–supine FVC (r = −0.64, p = 0.001). Respiratory impairment was predicted by bilateral mean PN CSA (p = 0.046, optimum cutoff value of ≤0.37 mm2, sensitivity = 92%, specificity = 56%) and by the sum of PN and AN CSA (p = 0.036). The combination of ALSFRS‐R score with PN and AN CSA measures predicted 1‐year survival with similar accuracy as the combination of ALSFRS‐R score and FVC.ConclusionsUltrasonography detects degeneration of cranial nerve motor fibers. PN and AN calibers are tightly related to respiratory function and 1‐year survival in ALS.

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Section: Discussionsupporting

confidence: 87%

Ultrasonic detection of vagus, accessory, and phrenic nerve atrophy in amyotrophic lateral sclerosis: Relation to impairment and mortality

Walter,

Sobiella,

Prudlo

et al. 2023

Euro J of Neurology

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“…A difference greater than -15% between the sitting and supine VC strongly suggests diaphragm weakness. 59 Measurements of vital capacity can be performed in a pulmonary function laboratory, an outpatient office, or at home by patients using a personal spirometer. 60,61 Hand-held "smart" spirometers such as the MIR Spirobank Smart (Medical International Research, New Berlin, WI) and the NuvoAir Air Next (NuvoAir, Boston, MA) spirometers (Figure 6) can automatically transmit data to a patient's phone or tablet for subsequent transmission to clinicians.…”

Section: Vital Capacitymentioning

confidence: 99%

Practical Guide to Management of Long-Term Noninvasive Ventilation for Adults With Chronic Neuromuscular Disease

Hansen‐Flaschen

Ackrivo

2023

Respir Care

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Recent technological advances in respiratory support and monitoring have dramatically enhanced the utility of long-term noninvasive ventilation. Improvements in quality of life and prolonged survival at home have been demonstrated for several common chronic neuromuscular diseases. Many adults with progressive neuromuscular respiratory disease can now comfortably maintain normal ventilation at home to near total respiratory muscle paralysis without needing a tracheostomy. However, current practice in many communities falls short of that potential. Mastery of the new technology calls for detailed awareness of the respiratory cycle, expert knowledge of mechanical devices, facial interfaces, quantitative monitoring tools for home ventilation, and a willingness to stay current in a rapidly expanding body of clinical research. The depth and breadth of the expertise required to manage home assisted ventilation is giving rise to a new focused medical subspecialty in chronic respiratory failure at the interface between pulmonology, critical care, and sleep medicine. For clinicians seeking pragmatic "how to" guidance, this primer presents a comprehensive, physician-directed management approach to long-term noninvasive ventilation of adults with chronic neuromuscular respiratory disease. Bilevel devices, portable ventilators, ventilation modalities, terminology, and monitoring strategies are reviewed in detail. Building on that knowledge base, we present a step-by-step guide to initiation, refinement, and maintenance of home noninvasive ventilation that is tailored to patientcentered goals of therapy. The "quantitative" approach recommended here fully incorporates routine monitoring of home assisted ventilation using technologies that have only recently become widely available including cloud-based device telemonitoring and noninvasive measurements of blood gases. Strategies for troubleshooting and problem solving are included.

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“…They stressed, however, that this threshold was an “expert opinion [and it was] …not intended as a recommendation for clinical practice” [ 8 ]. More recently, B rault et al [ 9 ] assessed 84 patients, 17 of whom had bilateral diaphragm dysfunction (where diaphragm dysfunction was defined as a diaphragm thickening fraction ≤30% during maximal inspiration); they concluded that a ΔSVC value ≤15% was strongly associated with the presence of bilateral diaphragm dysfunction. Only two patients among those with bilateral diaphragm dysfunction had COPD (the mean± sd FEV 1 /FVC for the group with bilateral diaphragm dysfunction was 79±9%).…”

Section: Does a Near Normal Fvc Signify Preserved Respiratory Muscle ...mentioning

confidence: 99%

Pearls and pitfalls of respiratory testing in a patient with amyotrophic lateral sclerosis and COPD

Littleton

Laghi

2023

Breathe

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Predictive value of positional change in vital capacity to identify diaphragm dysfunction

Cited by 13 publications

References 42 publications

Ultrasonic detection of vagus, accessory, and phrenic nerve atrophy in amyotrophic lateral sclerosis: Relation to impairment and mortality

Ultrasonic detection of vagus, accessory, and phrenic nerve atrophy in amyotrophic lateral sclerosis: Relation to impairment and mortality

Practical Guide to Management of Long-Term Noninvasive Ventilation for Adults With Chronic Neuromuscular Disease

Pearls and pitfalls of respiratory testing in a patient with amyotrophic lateral sclerosis and COPD

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